Diabetes Mellitus occurs when your blood sugar levels are too high. This can cause damage to blood vessels throughout your body. Many diabetics develop problems with their feet, kidneys, and heart due to poor blood flow.
Diabetes also affects the blood vessels in the eye, known as diabetic retinopathy. Even if you aren’t having any trouble with your vision; an ophthalmologist might notice diabetic changes in your eye when having a dilated eye exam. It is important to have yearly exams even if you don’t have any diabetic retinopathy because early detection and treatment can prevent future vision loss.
There are two types of diabetic retinopathy:
- High blood sugar affects the lining of your eye’s blood vessels causing fluid to leak out and damaging the retina
- Unhealthy blood vessels become smaller and don’t supply the retina with enough oxygen leading to ischemia which can also damage the retina.
- The lack of blood flow and oxygen causes your eye to form new blood vessels (neurovascularization) to compensate for this lack
- These blood vessels are fragile and may bleed. Blood inside the eye may look like floaters or potentially block all the vision in that eye
- The new blood vessels may scar causing a tractional retinal detachment
- If neurovacularization forms on the iris (colored part of the eye), glaucoma may result
Treatment of nonproliferative diabetic retinopathy is only needed if it affects the macula. The macula is the part of retina responsible for your central vision. Treatment involves laser surgery, which is done in the office, to the leaky blood vessels to lower the risk of further damage. Depending on the severity, injections of medicine into the eye may be used as well.
Treatment of proliferative retinopathy also involves laser surgery, which is more extensive than we use to treat nonproliferative retinopathy. Laser treatment does not get rid of the blood. Over time, your eye usually absorbs the blood and your vision improves. If bleeding persists despite laser treatment, surgery may be needed in the operating room.
Undergoing laser treatment, injections, or ocular surgery does not cure diabetic retinopathy. You may need multiple treatments over time. It is important to have and maintain control of your blood sugar and blood pressure.
The American Academy of Ophthalmology recommends Type 1 Diabetics to have an eye exam within 5 years of diagnosis and then yearly. Type 2 Diabetics should have an eye exam as soon as they are diagnosed and then yearly. Pregnant women who are diabetic should have an eye exam in the first trimester because diabetic retinopathy may worsen during pregnancy.